Hahnemann at first gave repeated doses-Instances of his repetitions-He afterwards attempted to regulate the repetition by the supposed duration of action of the medicine-Afterwards his rules was that the medicine should not be replaced as long as improvement went on-Difficulty of following Hahnemann’s rule-The medicine has not exhausted its action until improvement stops-He next allows the medicine to be repeated before it has exhausted its action-He allows the rapidity of the course of the disease to determine the repetition-The medicine when repeated must be given in a lower dilutions-He latterly allowed the medicine to be repeated very frequently, even in chronic diseases-But each time in a different potency-AEgidi asserts the advantage of more frequent repetition-Wolf advises more frequent repetition-Hering enumerates cases where repetition is useful-Gross and Kretschmar advise repetition in certain cases-Rau attempts to show when repetitions are useful, when hurtful-Kampfer’s rules for the repetition- Attomyr looks to the provings for the rules for the repetition-Attomyr’s un-Hahnemannic directions-Koch’s rules- Griesselich’s laudation of repetition-Circumstances in which it is to be employed-Periods of exacerbation of the disease ought to regulate the repetition-Trinks’s rules for the repetition- Arnold’s maxims-Attempt at a rule for the repetition in acute and chronic diseases-The exacerbations, periodicity, and rapidity of diseases should regulate the repetition-The dose cannot guide us in the repetition-Some homoeopathists contend for rare repetition, though Hahnemann latterly renounced the practice.
THEORETICALLY it might be inferred that the proper remedy having been discovered for the disease, and the appropriate dose having been found, all that remained for the physician to do was to place this dose of this remedy on the patient’s tongue, and this would amply suffice to effect the cure of the disease. Such a priori reasoning is encouraged by various parts of Hahnemann’s teachings, especially during the latter period of his life; thus his teaching in the Organon is that the dose of the appropriate medicine cannot be too small, so that it shall not be stronger than the disease to which it has a homoeopathic relation, and the logical inference from this of course is, that one single dose of one remedy is quite enough in acute as well as chronic diseases; and according we find this to have been Hahnemann’s doctrine and practice at one period.
But I am anticipating. This subject, like the others that I have in former lectures brought under your consideration, I shall proceed to consider historically, that is, I shall give you Hahnemann’s first practice, as far as that can be learned from his writings, and trace its gradual development in his mind, showing you the modifications his views and practice underwent with the growth of his system, and pointing out the circumstances that influenced his practice with respect to the repetition of the same medicine.
In the first essay he wrote announcing the discovery of the homoeopathic law in 1796, (Lesser Writings, p.295.) we find him giving the homoeopathic medicines–in considerable doses, as I formerly showed–very much in the same manner as the ordinary practitioners adopted, to wit, once or twice a day, in maladies of a chronic character. The case of colicodynia treated by him in the same year (Lesser Writings, p.353.) got the remedy also every day, but even at this period of his career he was conscious of what is called the cumulative action of certain medicines, such as digitalis and arsenic, and enjoined caution in their repetition. As regards the former of these medicines, he distinctly states (Ibid., p.328.) that its action lasts several days, and that therefore it might be attended with dangerous consequences to repeat the administration of even a small dose of it oftener than every two or three days, and he mentions a case where death ensued in consequence of giving only two grains of digitalis three times a day for three successive days; the effect in this case, he adds, in consequence of the long duration of the action of digitalis, was as if the whole eighteen grains had been administered at once.
In the two essays on intermittent and periodical diseases, published in the course of the following year 1798, (Ibid., pp.382,395.) no noteworthy difference is observable in his repetition of the medicines from what obtained and still obtains in the ordinary practice; thus six or seven grains of ledum, three times a day, is a prescription he used with success in a chronic affection remaining after the subsidence of a sort of remitting fever, and cinchona bark, half a drachm, twice a day, is what he gave in a case of intermitting asthma. It is not until we come to his treatment of scarlet fever that we find an attempt made to regulate the repetition of the remedy by its supposed duration of action. Thus the action of belladonna is supposed to last three days, (Ibid., p.437.) and its repetition for prophylactic as well as for curative purposes is enjoined to be made not oftener than every seventy-two hours as a general rule, excepting when the virulence of the disease is very great, when shorter intervals of repetition are recommended. That, however, Hahnemann did not yet consider the exhaustion of the action of the medicine should be waited for before giving another dose is evident from another passage in this essay on Scarlet Fever, where he directs a dose of belladonna every three hours, for the purpose of suppressing the disease when it first breaks out. (Ibid., p.441.)
It is not, however, till 1805 that we find a distinct enunciation of the rule of be observed in the repetition of the medicine. In the Medicine of Experience, published in that year, we find the following statement: (Lesser Writings, p.537.) “The repetition of the dose of a medicine is regulated by the duration of the action of each medicine. If the remedy acts in a positive (homoeopathic) manner, the amendment is still perceptible after the duration of its action has expired, and then another dose of the suitable remedy destroys the remainder of the disease. The good work will not be interrupted if the second dose be not given before the lapse of some hours after the cessation of the action of the remedy.”
But he adds, “the good effects of the medicine may be frustrated by its too rapid repetition–for this reason, because a dose prescribed before the cessation of the term of action of the positive medicine is to be regarded as an augmentation of the first dose,” in other words, the repeated doses accumulate in the system and act too violently. “After the expiry of the term of action,” he continues, (Ibid., p. 538.) “of the first dose of the medicine employed, we judge whether it will be useful to give a second dose of the same remedy.” And then he gives us the signs whereby we may know if the remedy was the proper one. We may be sure that the selection was correct if the disease have diminished in its whole extent, and it is probable that it was rightly selected if no new symptoms of importance have ensued, even though no perceptible amelioration should have occurred. In both these cases it is sometimes requisite, after the termination of the action of the first dose, to give a second or a third.
As regards the duration of the action of the medicines, Hahnemann had already, in his first essay On the Homoeopathic Principle, (Ibid., p.295) et seq. attempted to fix the periods of the duration of the action of several substances, at least of what he then called their direct or primary action; thus, according to him, the action of hyoscyamus lasted scarcely twelve hours; that of stramonium, in large doses, twenty-four hours, in small doses, only three hours; that of agaricus, from twelve to sixteen hours; that of aconite, from seven to eight hours; that of tobacco, in very large doses, twenty-four, in smaller doses, only a few hours; that of belladonna, twelve, twenty-four, or forty-eight hours; that of coffea, in large doses, two days, etc. etc.
In the first edition of the Organon, published in 1810, Hahnemann alters the rule he had given five years previously. Here the rule is, that the medicine should not be repeated as long as the improvement goes on, even though it be but slight; he says every new dose spoils the work of amelioration. This rule he considers much better and more important than his former one, because we do not know accurately the limits of the duration of the action of any medicine; some, for instance, exhausted their action in twenty-four hours (but he states this to be the shortest period of the action of any medicine he knows), whilst others continued to act for days and even weeks; the amelioration produced by the medicine also often continued perceptible after the action of the medicine was over.
The repetition of a medicine that had proved of use would, he tells us, only make the patient worse, if the amendment had not commenced on every point to stand still, thereby a medicinal disease would be added to the natural one; a disease when ameliorated presented a different group of morbid symptoms, and hence the same remedy was not again applicable. These directions, it will be observed, almost preclude altogether the repetition of any medicine, or, at all events, involve a contradiction that must somewhat have puzzled those who wished to act according to the exact directions of the Master; for, on the one hand, he says that a medicine is not to be repeated until the amendment the first dose produced becomes stationary, and again it is stated that any amendment will alter the morbid picture and indicate a totally different remedy.
It would be difficult to obey the first part of the directions without acting at variance with the second. However, even at this period it is evident that Hahnemann contemplated the occasional repetition of the medicine; for he says that when there is occasion to repeat it, we should always give smaller and smaller doses, and never give the patient the same dose. Some further explanation he gives us on the subject in this first edition of the Organon, where he says that the time for repeating the medicine is when some traces of one or more of the original symptoms of the former disease again showed themselves slightly. If, says Hahnemann–and here we have a diagnostic sign, the precise value of which it would be difficult to decide–if the patient require an equally large or still larger dose of the homoeopathic medicine (which always does him good) in order to prevent a relapse, this shows that the exciting cause of the disease still exists, or else that there is something wrong in the diet or regimen or circumstances of the patient that serves to keep up his malady.
In the fourth edition of the Organon he insists particularly on the necessary of not giving a fresh dose, or a new medicine, until the action of the first has expired, which we are able to pronounce it has not done as long as the slightest trace of amelioration is going on. This observation, he says, is the more important, as we are unable to tell the precise limits of the action of any medicine even in large doses, and even on the healthy individual, far less those of feeble doses in the great variety of diseases, and in patients of such very different constitutions. In a note he adds (Organon, 4th edit., Aphorism 241, note.) “This is true of the most acute as well as the most chronic diseases, because the duration of the action of a homoeopathic medicine is governed by that of each malady, and consequently it exhausts itself in a few hours in acute diseases, while it takes several weeks to complete its action in diseases that are very chronic.”
The fifth edition of the Organon, published in 1833, presents several striking differences from the fourth edition just quoted, and in nothing more than in reference to the repetition of the remedy. The same observation is retained here, to the effect that any new dose of the remedy administered before the former one has exhausted its beneficial action would do harm and could do no good; but immediately afterwards this observation is considerably modified, if not absolutely contradicted; thus, after stating (Organons, Aphorism ccxlvi.) and note. that the medicine will accomplish all the good it is capable of performing in forty, fifty, or one hundred days, he adds, that the beneficial action of it may be greatly accelerated by repeating the medicine at suitable intervals, and the cure abridged thereby to one half, one quarter, or even less time; and in Aphorism ccxlvii, he gives us the following directions, which, you will perceive, completely set at defiance the rule he had himself laid down at starting for the repetition of the dose:-“The dose,” says he, “may be repeated with the best, often with incredibly good results, at intervals of fourteen, twelve, ten, eight, seven days, and where rapidity is requisite, in chronic diseases resembling acute diseases, at still shorter intervals; but in acute diseases at very much briefer periods–every twenty-four, twelve, eight, four hours; in the most acute every hour, up to as often as every five minutes; in every case in proportion to the more or less rapid course of the disease or action of the medicine employed.” He retracts his former directions about letting the one dose exhaust its action before giving another, and says this method is only applicable to slight diseases, especially of young children and very delicate and excitable adults. Thus we here find him admitting another element as our guide in the repetition of the dose, viz., the rapidity of the course of the disease. Slow, lingering diseases, according to this plan will require the medicine repeated at longer, rapid acute disease at shorter intervals.
Not only was the rule inculcated in former editions of the Organon repealed by this sentence, but also the directions in the first edition of the Chronic Diseases, on the same subject published in 1828, where we find it stated somewhat dogmatically. “If,” says Hahnemann, “we do not allow the antipsoric medicines, be they ever so well selected, fully to exhaust their action, the whole cure will come to naught.” The same ideas are retained in the first volume of the second edition of the Chronic Diseases, published in 1835, where he dwells at great length (Chronic Diseases, 2nd edit. i., pp.153-158.) on the necessity of allowing the dose to expend its action in chronic diseases; this action will often last twenty, thirty, forty, or fifty days, nay, the practitioner must, he says, in some cases, be content to allow one dose to act uninterruptedly for weeks and months without giving another dose. The only case in which he will allow a rapid (?) repetition of the medicine is where the amelioration advances a certain length, and then stands still. Under such circumstances we may, he says, repeat the medicine in fourteen, ten, or even seven days, and he proposes the following mode of giving the remedy. If the 30th dilution have been first given, it should be repeated in the 18th dilution, and if this repetition, was advantageous, and more doses are required, we should give the 24th, then the 12th, or the 6th, if the chronic disease have assumed an acute character. In the same place he also proposes another mode of giving the medicine, which admits of an immediate repetition. The dose is to be dissolved in eight ounces of water, a third of this to be taken immediately, the second and third portions on the two following mornings; the solution being well stirred each time to alter the potency. That he actually at one period allowed one dose of a medicine to act for twenty or thirty days I have been assured by several who witnessed his practice about that time. His plan was to give one dose of the medicine he deemed most appropriate, and furnish the patient with ever so many powders of sugar-of-milk to take till next consultation, pour passer le tems, and make him imagine he was going on with the remedy. “Blind powders” (blind Pulver) was the appropriate name he bestowed on these make-believes.
But this was not the last of Hahnemann’s changes of views on the subject of the repetition of the remedy. In 1837, (Chronic Diseases, iii., 2nd edition, preface, quoted in my translation of the Organon, p.296.) he says, in direct opposition to the advice about repeating the same dose of the remedy which he had formerly (1833) given, “our vital principle does not well admit of the same unaltered dose of medicine being given to the patient, even twice, still less several times in succession. For in that case,” he continues, “the good effects of the former dose will be partly done away with, as there appear new symptoms and sufferings dependent on the medicine, and which obstruct the cure.
Hence,” he observes, “the many contradictions of homoeopathists among themselves in respect to the repetition of the dose.” But he asserts it is indispensable to give the same medicine repeatedly in many diseases, both acute and chronic, and he states the intervals he finds it necessary to repeat the medicines in: in acute diseases, it is necessary to repeat the medicine every six, four, two hours, and sometimes every hour or every half-hour; and in chronic diseases the remedy should be given not seldomer than every two days, but generally every day. But we have just seen that it does not do to repeat the medicine in the same dose,–are we then to give a different dilution every time we give the medicine? This is not necessary now that the dynamization-theory is an article of faith in the homoeopathic system, for what more simple way of altering the dose than by altering the dynamization,–and how, you ask, is this to be effected? merely by shaking the bottle in which the patient’s medicine is dissolved five or six times before each new dose. After he has taken a bottleful of–say the 30th dilution, in this manner, and we still consider it necessary to go on with the same medicine, we must not again dissolve globules of the 30th for his use, but go down the scale to the 24th, and give him the solution of this medicine as long as we judge fit, in the same manner. The same technicalities, mutatis mutandis, are applicable to the treatment of acute and of chronic diseases. If it was considered desirable to give the medicine by olfaction, the patient was made to smell as often as it was considered necessary, but each time in a bottle containing a lower potency; on this principle, supposing the patient were to go on with this olfaction for a month, at the end of that period he would be sniffing the mother- tincture of the medicine.
1. At the outset of his career, Hahnemann seems to have repeated his doses in much the same style as was usual among the ordinary practitioners.
2. He afterwards attempted to lay down a rule, that the medicine should not be repeated until its action was fully exhausted.
3. The conditions of the repetition, as I have shown, were of such a character as practically almost to prevent the medicine being ever repeated.
4. Subsequently the advantage of repeating the remedy at longer intervals in chronic diseases, and shorter intervals in acute diseases, was acknowledged, and the rule for repetition came to be, the medicine should be repeated at shorter intervals, in the direct ration of the rapidity of the disease.
5. At a still later period the repetition of the same potency was said to be injurious, and the medicine, though still ordered to be repeated, in some cases, as often as every half-hour in acute diseases, and not seldomer than every two days in chronic, was ordered to be given at each dose in a fresh dynamization, made by merely shaking the bottle that held the solution some five or six times.
From this statement it will be apparent to you how much and how often Hahnemann’s views respecting the repetition of the medicine altered. It is noteworthy that the period when he first mentions the necessity of giving medicines at very short intervals in acute diseases was about the time when the cholera invaded Germany, and it was probably an observation of the necessity of repeating the remedy with great rapidity in this disease, that thus modified his practice with regard to acute diseases generally. The dynamization-theory, which he had developed to a great degree, had doubtless its influence in altering his views respecting the necessity of giving another dynamization every time the medicine was to be repeated.
Let us now examine what others have written and practiced in reference to the repetition of the medicine.
Dr. Aegidi, in an article in Stapf’s Archiv, x Archiv, xii.i. expresses his dissatisfaction with the ordinary method of treating chronic diseases. He says, that giving one dose of a medicine, and waiting for six weeks or so without giving another, was often to lose six weeks of time, and though chronic diseases were undoubtedly sometimes cured by this method, yet the treatment generally lasted an outrageously long time. He considers that our success might be greater and speedier, if we adopted some alteration in respect to the frequency of the administration of the remedy, and he seeks to lay down some general rules for the repetition of the medicine. “After the administration of the suitable medicine,” he says, “one of two events certainly happens in the course of eight days: either,–